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03060013 CITY OFCUPERTINOt 'fi_ �" ' BUILDING DIVISION PERMIT ACOf,N.TRACTOR�NFOR ATI6"'NO, , BUR,DR9GADDRUS: MICHAEL COLLINS PP'am"NO03060013 10285 M ER's NAME: 10285 MORETTI DR PERMITOS5V"2/2003 CHAEL COLLINS NE: SANITARY NO, CONTROL NO. ARCHITECTIENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 =1 I� woo LICENSED CONTRACTOR'S DECLARATION Job Description Ou 1 thereby affirm thn I am licensed under pmsism ioof chapter 9(commcming p with Section 7IXM))afDivlNon 7 of the Business and Profession Code,and my license is A in full(area and affect. REVISION--IN HOUSE USE ONLY i,41� License Clam Lk,g eI- Date Contractor. NO NEW PERMIT ISSUED, ORIG. #02030027 q ARCHITECTS DECLARATION eeuu�,� I undesumd my plans Mdl be used At public mounds is LL 4i"ased Professional \ 0 OWNER.GUILDER DECLARATION \�\ .� I hereby alum that I am exempt from the Contractors License Law for the S 00 fallowing mature.(Section 70713,Business and Professions Cade:Any city or county . 2 which requires•permir to comstmct eller,improve,demol W,or repair my structure prior in its issuance,Am requires be applicant for such Permit to rile a signed statement F Valuation Sp8 (commencing with Satlan 7")of Division 7 ofthe Business and Profeasion.Cm4)or 3 Ihm he Is exempt OstermanNe and basis for the allcgeA that he is licensed pursuant tomeprovisions ortheContmtresLicenselaw(Chapter 9 Sq. Ft. Floor Area assumption.Any vioa4n of 1 0 7 Section 7071.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type' not mom Nan Bve hundred doll...(5500). 37514003 . 00 ❑I.mown"ofthepmpeny,mmyemploycowiNwagonfttrmlecompenmtion, will do the work,and thasstoetum la not Intended oraBemd for We(See.7044,Boniness �yg�� and Pronasion,Code:The Contractors License law dam not apply to an own"of 101 — FOUND A'1 gPA.PV1V d Inspections roperty pwho builds orimpmw:s mthrough whodo tat Both work himtelfor ough hit own employees,provided Outsuch improvements tae not intended"offered for We.If, 102 — PIERS ' however,me building or improvement it said within am year of compledon,the owner. builder will have the burden of praying that he did not Mid"improve for putpose of 103 — UFER 1e1t), 104 - REBAR ❑1,as Owner of she property.am exclusively contracting with limned mntmton to 105 - ANCHOR BOLTS construct the project(Sec.7044,Buslnm and Professions Code:)The Commutes Li. censelawduon ooupply to an owns,of property, vas mnt who builds or lmproeon,and. 106 — SEWER & WATER who comma farauoh rojecu with a cormactoKq licensed pursuant to the Conumtofa License Law. 202 - UNDERFLOOR PLUMBING l FAsk . .B&PC fm i n 203 - UNDERFLOOR MECHANICAL en ` 2 ' 204 - UNDERFLOOR FRAME WORKER'SCOMPENSATTONDECLARA N 205 - UNDERFLOOR INSULATION the byNlrmunderpwltyofperjuryamofthefallowingdeclarsdans: 301 - ROUGH PLUMBING I have and will maintain a CanlfiUte of C.me.I to self-insure for Workers Compere moan.a provided for by S"don 7700 or Oce Labor Code.f"the performance of the 302 - TUB & OR SHOWER permit 303 - ROUGH MECHANICAL ❑I have and will maintain Workers Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL 77M of me labor Cade,for me perfom.ma or me work far which this pemlt is located. My Worker.Compensation Incomes carrier and Policy number ma: 305 — FRAME Carrier. Polity No.: 306 - HOLDOWNS CER71Fl COMPENSATE OF TION INSURANCEPTION ORKERS' 307 — INSULATION Tlbissecdoe reed not becompleted lfthe permit is Income hundred dollars($100) 308 - SHEETROCK art"`) 309 - EXTERIOR LATH I Unify that in the perfumeee of me work for which this permit is issued.I shall not 310 - INTERIOR LATH employ any peon in my manmr m u m actual.subject to the Worimrs'COmpensadon Laws of CaOfomia.Dam icant 311 - SCRATCH COAT NOTICE NOTICE 1O APPLICANT:IL after making this Cenificae of Exemption,you should 313 - ROOF NAIL become subject m the Workers Compensation previsions of the labor Come,you must 501 - FINAL ELECTRICAL ENERGY w,Z forthwith comply with such provisions em or this permit shall N deed revoked. _ zo CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm mat them is.construction lending,teary far the performance at 503 — FINAL MECHANICAL ENERGY C> thework far which this permituWood(Sec.7(M,Ci,C.) Lcadcrs Name 504 - FINAL BUILDING ENERGY fl]Q Z Larches Add. 505 - FINAL ELECTRICAL U O 1 certify that 1 have read this applicnm.and mm that the above informeiun is 506 — GAS TEST !I.F contract.I gree to comply with all city and county oclinmm and sate laws relating to PLUMBING O� building conswcuon.and hemby aumarim represenutiron of anis city reenter upon me F W shovo-mentioncd property far impaction Purposes %FINAL F IN C L (We)agree to save,indemnify and temp hamlets me City of Cupertino againsty liabilWes,judgments,costs and expenses which may In my way same against said CityIAPPLIegmnuof DERSTANDSmINDmu PLY WITH ALL NONPOINT Issued by: I fNG Date r�;Signau'al'ApplimuCcuummmr LA'ns. /9 �+ y Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof the applicant or future Wilding Occupant team or handle hams dove material ned by the Cupertino M iciptl Code.Cthapter 9.@,aM the Hcalm and SafetySection 25573(a)? All roofs shall be inspected prior to any roofing material being installed. DY" Nu Will the epp1,Omt r f tare building occupant tau cyuipmcnt or devices whichIfa roof is installed without first obtaining an inspection,I agree to remove araNOm air conumi nu mdefied by lie Bay Area Air Quality Management all new materials for inspection. t? ❑rns Nu 1 have read the hyyrndmnmamruls requiremenu under Chaium 6.95 of de C.liror. ".11.10h&seetyQ6,Secd"ts25505,25577 and 25534.1 undersuM that ifde Wilding does ret e h c a tenane mal i 6 an eee��nsibilily m audit,the OeeuPmt of the royui m m"p m m 'f¢atearacap Signature of Applicant Date G Owterm.ut .d.irca, Yaw All roof coverings to be Class"B" or better